Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data.

Lesley J Robertson,Christopher P Szabo

doi:10.4102/sajpsychiatry.v23i0.1055

Lesley J Robertson, Christopher P Szabo

Open Access

https://doi.org/10.4102/sajpsychiatry.v23i0.1055

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Abstract

BackgroundCommunity mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents.AimThe aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy.MethodsThe CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed.ResultsThe organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover.ConclusionOur audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

Highlights

In South Africa, community-based mental health care is a requirement of the Mental Health Care Act of 20021 and a central objective of the National Mental Health Policy Framework and Strategic Plan 2013–2020 (MH Policy).[2]
We studied the cleaned data for the Gauteng region served by the University of the Witwatersrand, that is, the two metropolitan areas of City of Johannesburg (COJ) and Ekurhuleni, and the two districts of Sedibeng and West Rand
Most mental health care users (MHCUs) collected repeat prescriptions from the community mental health services (CMHS) nursing staff; http://www.sajpsychiatry.org more stable users would collect from primary health care (PHC) nurses and return to the CMHS for medical review

Summary

Introduction

In South Africa, community-based mental health care is a requirement of the Mental Health Care Act of 20021 and a central objective of the National Mental Health Policy Framework and Strategic Plan 2013–2020 (MH Policy).[2]. The bulk of care should be provided by primary health care (PHC) practitioners, with specialist supervision and care for MHCUs with more complex conditions requiring specialised assessment and/or intervention.[3] The MH Policy positions the specialist CMHS back-to-back with general hospital acute psychiatric units within an intervention pyramid. They are tasked with providing continuity of care for the severely ill after hospital discharge, facilitation of hospital referrals, supervision of PHC, community outreach, and engagement with non-health sectors such as the South African Police Service, local schools and non-governmental organisations. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents

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